While COVID-19 is accelerating the migration of physicians to hospital employment, some hospitals have doubled down on measures that are making it hard for private practice physicians to remain independent.
The decline of independent physician employment is not new. Around 70 percent of physicians in the U.S. are employed by hospitals or corporations, according to a 2021 Avalere report. And during the first year of the pandemic, 48,400 physicians left independent practice for employment.
In December, a lawsuit was filed against Duke University Health System by a physician who alleges the health system is requiring clinical research faculty physicians to become its employees. The suit says the health system is attempting to "take over the [Private Diagnostic Clinic] over the physicians' objections and without paying for the practice's fair value."
The Durham, N.C.-based health system created a new faculty practice in July and mandated faculty in clinical departments who perform research join the group and become fully employed by July 2022. The employment requirement will force 400 members of PDC, a 1,850-member physician practice, to leave the group.
Last week, University of Iowa Health Care raised concerns over Iowa City, Iowa-based Steindler Clinic's planned $19.2 million ASC.
In Steindler Clinic's application, the clinic said the ASC will satisfy the area's need for competition, citing University of Iowa Health Care's new hospital and clinic.
"The UIHC North Liberty project is clearly targeting the patient population traditionally served by the private practice community in Johnson County," the application said. "What payers, patients, the community and private physicians need, and what this certificate of need application represents, is a choice. That is competition."
The clinic also argues that denying the application could lead to a monopoly by University of Iowa Health Care and reduce access to private practice physicians in the area. The health system says the new ASC would duplicate underutilized space at UIHC's existing facilities.
Physician migration from private practice doesn't look like it'll stop anytime soon.
Early-career physicians favor employed opportunities over private practice as declining reimbursements, steep medical school debt and the cost of malpractice insurance premiums remain key factors driving career choices.
Only 14 percent of physicians under 40 are self-employed, compared to 29 percent of physicians between 40 and 69 years old, according to Medscape.
Some hospitals and private practices have found success in working together.
The Bone & Joint Center, Albany (N.Y.) Medical Center and Saratoga Hospital joined forces to open a $19.1 million surgery center in Malta, N.Y. In designing the ASC, Jared Roberts, MD, the facility's medical director, visited ASCs in nearby cities and found that private practices have typically failed to form similar surgery center-hospital partnerships.
"There's no other that's like this in the country that I am aware of, that has a relationship that's a true partnership with a hospital system and connected to a 24-hour emergent care," Dr. Roberts said, according to an Oct. 5 Albany Business Review report.